Heavy cannabis use, neurocognition and PrEP care engagement among young Black sexual minority men

摘要：我们建议开展研究，以确定相关行为对艾滋病毒的影响 年轻黑人性少数群体男性（YBSMM）的预防，如大量使用大麻。信息的途径 小组和其他人证明，在YBSMM社区成员中，大量使用大麻的现象普遍存在，而且越来越多， 与艾滋病毒感染、作为性药物使用、更有可能参与艾滋病毒传播有关 减少艾滋病毒检测。我们建议探索机制，特别是神经认知的影响， 大量使用大麻，将大量使用大麻与艾滋病毒预防结果联系起来，以及 在大麻监管、社会接受度和法律的环境不断变化的情况下，大麻的使用改变了其影响 关于艾滋病预防。在拟议的研究中，我们将严格审查大量使用大麻， 神经认知，性行为和PrEP护理参与。首先，我们将阐明大麻使用对 神经认知-特别是支持风险/回报（RR）处理的大脑系统，以及更高层次的 组织职能在YBSMM中统称为执行职能（EF）。第二，我们将探索 大麻使用如何直接和通过神经认知影响与艾滋病毒预防相关， PrEP护理参与（主要结局）。拟议的研究将整合和扩大这些研究领域 在传统的卫生部门和疾病预防控制中心支持的艾滋病毒预防计划的背景下， YBSMM位于芝加哥南部和邻近郊区，是最大的连续多数黑人的家园 人口在美国。我们将使用严格的客观措施来评估大麻的使用（例如，定量 血浆中的大麻代谢物），神经认知（例如，神经成像）和PrEP结果（例如，测量的EMR 持久性），并使用经过验证的调查措施对数据进行三角测量。我们还将严格考虑其他 物质使用，在使用大麻的YBSMM中也使用其他物质（例如，酒精），以及 越来越多的人认识到，有必要研究物质使用，因为它发生在现实世界中，包括 多物质使用。我们将在1.5年（间隔3 × 9个月）内纵向评估这些因素， 队列280 YBSMM生活没有艾滋病毒，允许检查个人内的生物变化和 大麻使用的动态性质及其与预防保健结果的关系。我们的目标是：1）确定 大麻使用和神经认知之间的横向和纵向关联（即，神经反应 风险/回报处理和执行功能）; 2）评估整体，直接和间接 (via神经认知）大麻使用和PrEP护理之间的关联（例如，持久性[主要]）和艾滋病毒 传输行为（例如，群体性[次要]）;以及3）确定使用大麻的动机是否 修改大麻使用与艾滋病毒预防结果之间的关联。识别神经认知 大麻使用影响艾滋病毒预防的机制以及大麻使用动机的重要性 用于了解临床结果将为未来的艾滋病毒预防工作提供目标。

ABSTRACT: We propose to conduct research that will determine the impact of relevant behaviors on HIV prevention among Young Black Sexual Minority Men (YBSMM), such as heavy cannabis use. Data from our group and others demonstrate heavy cannabis use as prevalent and increasing in YBSMM community members, is associated with HIV acquisition, use as a sex-drug, greater likelihood of membership in an HIV transmission cluster, and decreased HIV testing. We propose to explore mechanisms, specifically neurocognitive impacts of heavy cannabis use, linking heavy cannabis use to HIV prevention outcomes, and whether motivations for cannabis use, amidst a changing cannabis regulatory, social acceptance and legal landscape, modify its effects on HIV prevention. In the proposed study, we will rigorously examine links between heavy cannabis use, neurocognition, sex behavior and PrEP care engagement. First, we will elucidate the effects of cannabis use on neurocognition - specifically, brain systems supporting risk/reward (RR) processing, as well as higher order organizational functions collectively referred to as executive function (EF) in YBSMM. Second, we will explore how cannabis use, directly and via neurocognitive impacts, is associated with HIV prevention, and particularly PrEP care engagement (primary outcome). The proposed study will integrate and expand these lines of research within the context of traditional health department and CDC supported HIV prevention programs that engage YBSMM in the South Side of Chicago and adjacent suburbs, home to the largest contiguous majority Black population in the US. We will use rigorous objective measures to assess cannabis use (e.g., quantification of cannabis metabolites in plasma), neurocognition (e.g., neuroimaging) and PrEP outcomes (e.g., EMR measured persistence), and triangulate that data using validated survey measures. We will also rigorously account for other substance use, as a proportion of YBSMM who use cannabis also use other substances (e.g., alcohol), and there is increasing recognition of the need to study substance use as it occurs in real-world settings, including polysubstance use. We will assess these factors longitudinally over 1.5 years (3 times 9 months apart) in a cohort of 280 YBSMM living without HIV, to permit examination of within-individual biological changes and the dynamic nature of cannabis use and its association with prevention care outcomes. We aim to: 1) Determine cross-sectional and longitudinal associations between cannabis use and neurocognition (i.e., neural response to risk/reward processing and executive function) in a cohort of YBSMM; 2) Evaluate overall, direct and indirect (via neurocognition) associations between cannabis use and PrEP care (e.g., persistence [primary]) and HIV transmission behaviors (e.g., group sex [secondary]); and 3) Determine whether motivations for cannabis use modify associations between cannabis use and HIV prevention outcomes. Identifying neurocognitive mechanisms through which cannabis use affects HIV prevention and the importance of motivations for cannabis use in understanding clinical outcomes will provide targets for future HIV prevention efforts.